Abdominal surgery

Since July 1, 2017, Professor, Doctor of Medical Sciences Wolfgang Schwenk has headed the Clinic for General and Visceral Surgery of the City Clinical Hospital in Solingen, Germany.

Stumbling blocks

The Asclepios Clinic in Hamburg-Altona District is a tall building that seems simply huge. It is located two steps away from me; this is, so to speak, my neighbor. Always, when I am going to the city in the evening, whether by metro or by car, or when I return home in the dark, I look at the illuminated windows of the Clinic. In addition, I always have this feeling of happiness and gratitude for the fact that I am not one of those who languish somewhere behind one of these windows. One, who is there, is sick ... they have to undergo an operation or have already undergone surgery; they hope that the pain will finally weaken, and their fears will soon become less. Every year here, 80,000 outpatients and inpatients place hope in highly effective, as well as integrative medicine. In addition, the history of the Clinic began in 1784, even when Altona belonged to the territory of Denmark.

NEED TO BE REALLY CRAZY...

Behind one of these windows, there is Prof. Wolfgang Schwenk, MD, chief doctor of the General and Visceral Surgery Clinic of the Center for Minimally Invasive and Oncological Surgery. In his department, all surgical diseases of the abdominal cavity and endocrine glands are treated. With the help of minimal incisions, he always, if possible, copes with the most ambitious tasks: tumors of the endocrine glands, malignant diseases of internal organs and intestines. After a long working day lasting more than 12 hours, he tells me in his office: “The one who chooses the surgeon’s profession must be really crazy! However, even if it is crazy, it is still the most beautiful profession in the world. I would not want to do anything else. This work is my passion. It means every day a new admiration and a new challenge to help people”. His eyes sparkle at the same time.

It is hard to imagine that you have ever emanated boredom or satiety. Thousands of days of his life the surgeon, who regularly gets on the list of the best, spends in the operating room. Prof. Schwenk, before taking up the post of the chief doctor of the Clinic of Hamburg-Alton five years ago, for many years had been the senior doctor and deputy director of the Charite Clinic in Berlin.

The range of diseases in his department is especially large. After all, the area of visceral surgery extends from the neck area, more precisely, the thyroid gland, to the inguinal area and anus. However, the scars left by the doctors, on the contrary, are small, and are becoming smaller. They cannot be compared to those similar to the bite of a saber-toothed tiger, scars that remained in patients 20 years ago. Now we are discussing this topic with the professor who masterfully owns this technique of conducting operations.

IF THE GALLBLADDER NEEDS HELP

One of the most frequent surgical interventions in his clinic, as well as, according to the list of Focus Magazine, the most high-quality interventions are gallbladder surgery, because 200,000 operative procedures for removing gallstones are performed annually in Germany. Anyone who has at least once experienced a wave of pain that looks like little monsters that pierce the body is very happy if their organ is empty. Although the gallbladder is not a vital organ, it plays an important role in the process of digestion of fats. In the gallbladder, a bitter liquid coming from the liver is collected and concentrated. After meals, it moves to the intestines so that the edible fats can be digested well. Since bile is quite aggressive, it is not surprising that the gallbladder often gets sick. Especially often, there are biliary calculi, formed from concentrated digestive juice, and as a result, the above described painful colic and inflammation may occur. “Currently, the preferred method of removing the gallbladder is the laparoscopic surgical method. Approximately 90% of all operations on the gallbladder are carried out in this way. You belong to those surgeons who studied the so-called “large incision of the abdominal wall” - what is the advantage of a minimally invasive operation?”- we ask the professor.

“There is not one advantage ... there are several of them at once,” the specialist answers. “I think that laparoscopic surgery is a real success for patients. Due to small incisions of the abdominal wall, patients after the operation have fewer painful sensations and they quickly get back on their feet. They recover more quickly than after a traditional operation, and in most cases they are discharged from the clinic within 2-4 days after the operation. Do not underestimate the cosmetic advantage – after the operation there are only tiny scars that are almost invisible.”

Video games also have advantages

Are there situations in which the gallbladder still needs to be removed in the traditional way? Professor Schwenk: “Only with severe inflammation and special problems. For example, if complications arise during a minimally invasive operation, doctors change the surgical method for an open operation.” In some cases, a larger incision of the abdominal wall after a previous surgery can lead to tissue fusion, which makes the minimally invasive removal of the gallbladder impossible. However, this is rather an exception.

This means that many younger surgeons can perform operations exclusively with a minimally invasive method, and that with larger interventions they must adapt ... is this a joke? “So, lately everything has really changed,” the expert agreed. “When I started working, every young surgeon had to perform at least 20-30 open operations before he was allowed to perform operations with a minimally invasive method. Today everything is exactly the opposite. Now surgeons first study laparoscopy before they begin to study a major open operation. However, this is true; many colleagues for this reason are much more experienced in performing laparoscopic interventions.”

“And what will happen if the on-duty surgeon owns only one method, namely, minimally invasive?” We ask again. “Do not worry,” the doctor reassured. “At night, we always have surgeons on duty who know both methods.”

Do surgeons-men perform laparoscopic operations faster than surgeons-women do? Professor Schwenk smiles: “Yes, there is some truth in this, and there is one simple reason for this. As experience shows, boys play computer video games more than girls do – and therefore later it is easier for them to cope with laparoscopy, thanks to the sleight of hand. “However, thanks to the daily practice, surgeons-women quickly catch up.

SOLUTION: This is abdominal surgery!

It is very exciting to listen to a person who needs to be completely trusted if you give your health into his hands. Never a person is so dependent on another person than during an operation. Why did Wolfgang Schwenk, who was invited to replace the legendary surgeon of the Altona Clinic, Professor Wolfgang Teichmann, became a doctor? Was this decision made at an early age?

The doctor protests: “No, no. For a long time I have even thought about becoming a journalist like my father and my brother. At school, I was very interested in history and politics. Later, these subjects were supplemented by such natural sciences as biology and chemistry. “The opportunity to become a researcher also seemed like an excellent option. However, when the young Schwenk after graduation (average ball was 1,2) was practicing as a nurse, he suddenly realized how wonderful it is to help sick people. While studying at the medical faculty, which he entered very easily thanks to his good assessments, he remained on night duty in the intensive care unit and worked part-time in the emergency medical care unit. The theme of his doctoral dissertation was vascular surgery. “On this, with my thoughts of once working as an anesthesiologist, it was finished. I knew: This is surgery! It is my passion.”

Among the many opportunities I have chosen is the most large-scale: visceral (verbatim: surgery for internal organs) or abdominal surgery: "And this was the best solution in my professional life."

The first surgical intervention, which the young Schwenk did on his own, was a classic case in this area: an operation to remove the inguinal hernia. Do you have any memories of that very first time? “Yes,” says Professor Schwenk dryly, “the man survived ...”

MAGIC, WHICH NEVER ENDS

We touched the topic of life and death. However, we also touch upon the theme of magic of saving human life, which never depresses the surgeon! “You know”, says Professor Schwenk, “People come to us with a health problem that reduces the quality of their lives, or even, perhaps, threatens their lives. In addition, we, surgeons, thanks to our art, can solve this problem relatively quickly. We can restore the quality of life that the patient does not have. But...”

He stops for a moment. “What, however?”, I ask. “However,” says Professor Schwenk, “there is nothing else that could make a person so insignificant, so disbelieving in his own strength as surgery. In surgery, you experience a very great sense of satisfaction and complete satisfaction, however – absolutely honestly - also of despair. In such cases, you turn around at night in bed and ask yourself: “Why was that so? Could I have done something differently? Could I? Should I have been? What have I done wrong? Have I done something wrong? Why has this happened?”

Do you have examples of such sleepless nights? “Of course,” he nods. “Once we had a young 30-year-old patient who had only recently married. She was diagnosed with inflammation of the peritoneum. Up to the ninth day after the operation, everything went fine. However, then there was an intestinal bleeding, and the patient was re-operated many times. For many months, she remained in the intensive care unit, she spent eleven months in the clinic, her stomach was open for 70 days, washing and cleansing were carried out every day. She had an artificial anus. During my last rounds, in the evening I always came to her, “says Professor Schwenk,” I have NEVER left the clinic without visiting her. The young patient had never given up, and her family had always fought for the girl ... and I had never given up too. “These are exactly the moments, precisely the hardness by which the silk threads, on which human life hangs so often, are held gently but firmly. Not so much. Not too little. But first of all – never give up.

The professor takes a deep breath and says: “Recently I have seen her again. She lives a practically normal life. She no longer has an artificial anus. In the end, everything ended well. Nevertheless, it was a long way. "

Is there such a thing as the most beautiful operation?

“I once thought so,” says the doctor, “but in time I became smarter. I know that even an ideal operation can show a bad result. This is a dilemma in surgery. This is exactly what I understand by the word “humility”. Therefore, I never leave the operating room with the idea that this was an ideal operation. I watch how the further course of the disease develops and only sometime later, perhaps, I can say that everything went perfectly.”

The medical art of dexterous handling of a scalpel is a business designed to restore a person’s health. We call this simply medical competence. However, how important is emotional competence on the road to recovery? How important is it for your personal experience?

The biggest thing is how the doctor sees it. In addition, he tells the story of a grateful patient who every year on the day she underwent an operation comes to him and brings home baking or a bottle of wine for him as a gratitude. The doctor talks about the friendship that has arisen between him and one of the patients in the Clinic.

Professor Schwenk: “A man came to us with cancer of the duodenum. Cancer, which appeared almost like a bolt from the blue, without any symptoms, without warning - a nightmare. I operated on it. He carried it well, and the friendship that has arisen here in the clinic has survived to this day. These are the moments when I unequivocally assert: I have an excellent profession. “However, the friendship between the doctor and the patient is more like an exception, I object.

FACTOR OF HEALING – HUMANITY

“Of course,” he says. “However, I am 100% convinced that it is my personal experience that humanity, closeness, good contact with the patient accelerate the process of recovery. Therefore, it is very important for me personally and for our team to build trust relationships. The relationship between the doctor and the patient should be appropriate. Finally, the patient must trust the doctor.”

How can you build such a trusting relationship?

Professor Schwenk: “I talk with the patient before the operation. Moreover, not only about their illness. I am looking for an approach to it. I talk with them about the book on their bedside table, about their hobby, children, about any things common to us. The patient should feel as quickly as possible that I am more than just a white or green tunic, more than just an operating technician. This is important for oncological patients. Moreover, what about us? We try to convey to every patient that we play with them in the same team. WE WANT TO WIN!”

We finish our conversation and by this time the professor has spent more than 14 hours in the Clinic. Will he go on a run today ... it is more questionable. “The third factor, which is also important – apart from emotional competence and interest in the patient,” says the professor before we say goodbye to each other, is self-criticism. Anyone who behaves too self-confident takes away a chance to become better. After all, I can become better only if I question myself. In addition, we, as surgeons, should be good every day and always get better. In the end, patients trust us the most valuable – their lives.”

Since July 1, 2017, Professor, Doctor of Medical Sciences Wolfgang Schwenk has headed the Clinic for General and Visceral Surgery of the City Clinical Hospital in Solingen, Germany.